Self Trigger Point Release work (Manick's Case)

[Manick]

Oh, I apologize for not being more direct, but yes the last message was intended to be for the both of you.

As I said earlier, she gave me these exercises to do with tightening my abs even after I had explained to her that I had increased pain ever since I started working on my first set of stretches. She sounded somewhat surprised, shared that she wasn't very experienced with chronic prostatitis / chronic pelvic pain syndrome if at all, is unfamiliar with HITP, and said she found my case to be unusual. The one thing that has helped my pain very recently so far however, is a portable Travel Lite™ Cushion by lifeform, which she had prescribed for me and referred me directly to a store that sold them. By the end of Thursday, I was in far less pain than I usually am on the end of Tuesdays/Thursdays in which I have 8hrs worth of classes and 3hrs worth of driving to do. I am going in tomorrow to have some internal TP release done though, so hopefully that helps more. I am just not sure how to go about telling her that I oppose the idea of tightening my abs and relaxing them as you say, because I'd hate to sound like I am telling my PT how to do her job based on something I read on a forum and completely change our protocol right in the middle. Most doctors so far that I've talked to haven't taken me too seriously if I try to talk to them about something I read on the internet to help the diagnosis. Some of her assessments are correct though, because my abdominal muscles are indeed damn near non-existent, I have trouble controlling them, and I haven't devoted myself to any type of exercising in a little over 4 years, so I am a very weak/frail person in general.

But should I consider seeing another PT if things don't improve over the next 3 sessions? I think that's all I have left then I am on my own. From what I've gathered by reading around on this board so far, most people seem to come out of their PT sessions feeling better and also become very knowledgeable on what appropriate stretches and trigger point releasing they need to be doing to relieve pain on their own even further.

[charles]

Definitely seek another PT if things don't improve.

If she admits that she isn't familiar with CPPS, and hasn't read HITP, I think it could be dangerous for her to try and advise you what to do. Again, your abdominal muscles may be weak and "nonexistant" but to strengthen/tighten them at this point could do more harm than good.

[Manick]

Thank you very much for your advise charles, I greatly appreciate it. I will look for that book on Amazon and order it immediately and try to convince my PT's that we may be doing more harm than good and see if I can get a second opinion as well. As far as stretches are concerned, would it be wise to follow the stretch holds from this link till I get better advise? http://www.freewebs.com/trydent78/
She had me doing a couple of the stretches which look very familiar, and they are stretches I had occasionally worked on in the past myself before I could even see a PT, but I don't think I've done them properly or often enough to make a difference. 3x / 30 second holds seems to be the average repetition for most stretches they assigned to me. Can the same be said for the ones on that link as well as the ones illustrated in HITP?

[charles]

The stretches and duration are probably fine.

I think the worst thing is any "tightening" of the abs.

Honestly, if you have another option, I would not spend anymore time with a PT who is not familiar with CPPS.

[Manick]

I have to correct myself. They do seem to be informed of CPPS, and I saw a different PT today at the same clinic for my 3rd appointment. This new one described what I originally thought as "tightening of the lower abdominal muscles" instead as "trying to hold in the urge to urinate", which made much more sense to me and felt much different than the previous exercises. The chronic prostatitis / chronic pelvic pain syndrome patients they told me they had mostly were runners, and right before my onset, I had also begun intensive walking/running/sprinting exercises for 30 mins each day without doing any warm-up stretches.

[timberdoodle]

If your trigger pain is on a scale of 1-10, you want to press enough to take your pain to about a 7 and then hold until it releases or for about 60-90 seconds.

Don't try to hit a "home run" each time you do it. You won't heal yourself in one treatment. Go slow; take your time.

I'm now 7 months from Dr. Wise's clinic, and I can say there has been improvement, but it's been slow. As Dr. Wise says, it's like watching the stock market. Don't watch the day to day ups and downs or you'll go crazy. Look at the 200 day moving average. Take the long view and be patient.

Best Wishes

[neue01]

Yes to be honest this happens a lot more then you'd like. I'm in one of these periods right now. I tightened an area up doing some routine maintenance massage one morning a week or so back and I'm still struggling to release the area. In this condition I tend to obsess about it and try again each morning and sometimes evening only aggravating it further. I've noticed the best thing to do is wait for 2-3 days and deal with the new pain until it calms down. At this point the muscle is more susceptible to being released more easily. It's easier said then done because dealing with the uncomfort and new set of symptoms brought on can be too much for the obsessive minded individual. Like I said I've tended to aggravate things because I can't just leave it alone and zen out with the discomfort.

[Manick]

Right next to post ejaculation/defecation pain, having a full bladder really seems to be the primary cause of extreme pain and flare ups. ESPECIALLY when I am sitting down.. It can get so bad at times that it feels like my entire lower abdominal area is full of sore trigger points. But then occasionally, whenever I empty my bladder, I get an incredible amount of relief. I hear of many people on these forums have pain while urinating, while I am the exact opposite. My bladder used to be so sensitive, that I could actually FEEL my bladder shrinking and emptying out while urinating, and at the same time feel like some of the irritation was fading away both immediately and later afterwards. Now, its not as bad anymore, especially since I've been taking the time to go to the bathroom whenever I feel like I should. Similarly, if I have not been eating well in the past few days and my bowels are full but I am unable to defecate, then my right side gets extremely swollen and tense. My swelling of course reduces immediately if I empty my bowels, but my IBS then sometimes kicks in and can make it swell right back up.

My Psychiatrist suggested taking Alpha Blockers again, which is something I tried once before after I was initially diagnosed with Prostatitis months. But after a month on these between Uro sessions, I didn't notice any change in symptoms (probably because back then the pain was a lot worse and easier to trigger, and I wasn't yet aware of what habits or food/drink intolerance's made chronic prostatitis / chronic pelvic pain syndrome worse). He said that if I was having pain with both defecating and ejaculating, then my soft tissue "tubing" may be overly sensitive and causing flare-ups, so he prescribed me an anti-anxiety / alpha blocker pill called "Guanfacine". I also have some Uroxatral left over from my Urologist meetings.

Does it sound like Alpha Blockers may be the type of medication thats best for my case based on what I mentioned? I feel like Valium and Elavil isn't working nearly as well as they used to. They do seem to still help me with Anxiety and Insomnia (which is a side effect of another drug I am taking), but don't seem to neutralize my muscle tension quite as well as they used to.

[Manick]

Right now, I am faced with the last of my challenges to overcome, and then I can finally foresee myself on the way to recovery. Currently, my bowel movements have been inducing the most pain out of anything else, and is really beginning to drastically reverse all of my efforts and progress made over the past 4 months to conquering this disorder. I have already been to a PT about my CPPS, but they were not able to help me understand why I was getting flare-ups from pre & post bowel movements. The stretching they told me to do didn't seem to help much with it either, but did help in other areas. The only methods or preemptive strategies I have read about towards preventing or reducing pain have been the following:

1) Squat while having a BM (this seems to help only if I have consistent BMs, once every day or two)
2) Avoid constipation or diarrhea. (Elavil gave me constipation, so I withdrew from it completely)
3) Avoid straining or forcing and allow muscles to relax. (Unfortunately most of the time, pain still follows even if I do not have to strain or force. But it is significantly better)
4) Avoid urinating during, or shortly after a BM, even if you need to hold it.
5) Take a hot bath after having a BM (Or should it just be luke-warm? Someone please clarify this for me).
6) Avoid any foods that you might have an allergic reaction to. (glutten/wheat was ruled out, and now I can start consuming more fiber based foods on a daily basis)
7) Drink plenty of water (which I have not been doing as much lately)
8) Avoid pro-longed sitting immediately following a BM. (I found that sitting and even standing makes the pain worse, so I've started to lie down after BMs).

Is there anything else I am missing? What has worked for some of you other folks that suffer from BM pain, even if I already listed it (just to relate)? I am really at a loss here, but I've not been panicking or overly anxious about this issue; I am simply looking for more answers. I've done most of these things but still have inconsistent bowel movements (once every 3-5 days, then sometimes for 2 consecutive days at random regardless of what I've eaten). Granted, I've only recently had an blood allergy test done that concluded that wheat/glutten was fine for my diet, so I can continue eating cereal, which has been my primary source of fiber for a very long time. That, and I and my psychiatrist have concluded that I was too sensitive to Elavil and it was causing Constipation, so I am no longer taking it. So please, I ask that everyone who reads this thread and suffer or have suffered from BM pain share your experience with what has worked for you, and what you've had to avoid.

[torontomale]

This is what fixed my IBS like symptoms . I have this for breakfast. I know some people have problem due to wheat but wheat fixed mine I guess..

[mapletop]

Torontomale. Thats what fixed mine too.

[Manick]

Now that Christmas break is here, I have been able to take it easy for the past couple of weeks with no stress at all and have been recovering rapidly, but recently had relapse of pain unfortunately.

Having said that, I have a concern about TP release that has been bothering me for quite some time now. It seems after a bowel movement, regardless of stool softness or regularity, I get a sharp cramp like pain in my gut, accompanied with an increase in blood pressure in the area. I can feel my pulse very easily and when I attempt to release some trigger points in the area, and I am afraid I am agitating it more. My PT said that if I felt any pulsating when doing my own TP therapy, then I should let off and leave it alone. But that basically means that I cannot ever perform TP release when pain is present, which does me no good, since the trigger point agitation and pulsating appear together. Can anyone explain why this is happening and confirm if I should stop attempting TP release under these conditions?

[Manick]

I recently spoke with my Psychiatrist about my pains and based on what I described it as this time around, and he said it sounded like I had a hernia. Initially, that is what I thought I had, but for some reason wrote that off as not being a possibility early on after I first started having the pains. But now, it seems a lot more likely based on what I am noticing. I have noticed and relayed to my psychiatrist, that I have a big stiff bulge of "something" underneath the left side of my belly, which when touched and pushed on does not hurt, and can be painful if overly irritated (especially after bowel movements). If I could describe its shape/texture, id say it felt cylindrical, about 3-4 inches in length, 1 1/2 inches in diameter, and feels very tough yet soft. If I am careful and push on it lightly, but firmly, I can sometimes reduce the bulge and swelling in the area (however, it is not physically noticeable; only by touch) and sometimes reduce the pain in that area and also in neighboring areas. However, sometimes it can immediately swell back up or drop back down (depending on what its actually doing) and get even worse, especially if I obsess over it and press/push on it too much or too hard. I also noticed that my organs start making a lot of noise sometimes when I press and push on it, which a urologist recently told me is a good sign of a hernia. Could anyone help me shed some light on this and maybe give me a better idea what the difference is between a hernia and just some swollen/inflamed soft muscle (CPPS)? I was also told by my psychiatrist that the pelvic floor muscle cannot be felt externally and underneath the left side of my belly.

[carld]

Manick,

Hernia is something that needs to be determined by a doctor...

Just a thought and non of my business...but perhaps you should change your name from "Manick" to something else...It's like shooting your self in the foot, when a huge part of recovery starts in the mind...

Just a thought...

Best

[webslave]

I was also convinced I had a hernia. It took a surgeon to convince me otherwise.